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Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic





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Abstract
Objectives: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.Design: Prospective, randomised, open label, blinded endpoint study.Setting: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.Participants: Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥ 8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded.Main outcome measures: The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events.Results: The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group.Conclusions: An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores.
Item Type: | Article |
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Authors/Creators: | Black, JA and Campbell, JA and Parker, SC and Sharman, JE and Nelson, MR and Otahal, P and Hamilton, G and Marwick, TH |
Keywords: | cardiology, rapid access chest pain clinic, quality of life |
Journal or Publication Title: | Medical Journal of Australia |
Publisher: | Australasian Med Publ Co Ltd |
ISSN: | 0025-729X |
DOI / ID Number: | 10.5694/mja2.50960 |
Copyright Information: | Copyright 2021 AMPCo Pty Ltd |
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